Provider Demographics
NPI:1790292159
Name:COOK, PATRICIA ANN (PMHNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:213 WEST MAIN STREET MALONE NY
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1246
Mailing Address - Country:US
Mailing Address - Phone:518-481-8744
Mailing Address - Fax:
Practice Address - Street 1:213 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-9577
Practice Address - Country:US
Practice Address - Phone:518-481-8744
Practice Address - Fax:518-481-8543
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632597163WP0808X
NY402670363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05320310Medicaid